AdventHealth Translational Research Institute, 301 E. Princeton Street, Orlando, FL, 32804, USA.
AdventHealth Diabetes Institute, Orlando, FL, USA.
Curr Cardiol Rep. 2021 Jun 3;23(7):75. doi: 10.1007/s11886-021-01505-3.
This review summarizes recent cardiovascular outcome trials (CVOTs) with glucose-lowering drugs.
The majority of recent CVOTs with glucose-lowering drugs have tested dipeptidyl peptidase-4 inhibitors (DPP4-i), glucagon-like peptide-1 receptors agonists (GLP1-RA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i), but studies have also been performed with other agents including thiazolidinediones and insulin. All CVOTs with DPP4-I, GLP1-RA, and SGLT2-i have demonstrated the cardiovascular (CV) safety of these agents compared to usual care. However, certain GLP1-RAs (liraglutide, subcutaneous semaglutide, albiglutide, dulaglutide) and SGLT2-i (empagliflozin, canagliflozin) have demonstrated a CV benefit, showing significant reductions in composite cardiovascular outcomes. Furthermore, all SGLT2-i also significantly decreased the risk for hospitalization for heart failure. Results from these studies have altered clinical guidelines worldwide and have resulted in new indications for some glucose-lowering drugs. In patients with T2D and high risk for CVD, GLP-1RA or SGLT2-i with proven cardiovascular benefit are recommended, irrespective of glycemic control.
本文总结了近期降糖药物的心血管结局试验（CVOT）。
近期大多数降糖药物的 CVOT 研究涉及二肽基肽酶-4 抑制剂（DPP4-i）、胰高血糖素样肽-1 受体激动剂（GLP1-RA）和钠-葡萄糖协同转运蛋白 2 抑制剂（SGLT2i），但也有研究涉及噻唑烷二酮类和胰岛素等其他药物。与常规治疗相比，所有 DPP4-i、GLP1-RA 和 SGLT2-i 的 CVOT 均证实了这些药物的心血管（CV）安全性。然而，某些 GLP1-RAs（利拉鲁肽、皮下注射索马鲁肽、阿必鲁肽、度拉糖肽）和 SGLT2-i（恩格列净、卡格列净）显示出 CV 获益，显著降低了复合心血管结局。此外，所有 SGLT2-i 还显著降低了心力衰竭住院风险。这些研究结果改变了全球临床指南，并为一些降糖药物带来了新的适应证。对于有 CVD 高风险的 T2D 患者，无论血糖控制如何，均建议使用具有明确心血管获益的 GLP-1RA 或 SGLT2-i。
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